Journal of Behavioral Medicine

, Volume 16, Issue 6, pp 629–642 | Cite as

Tobacco-refusal skills and tobacco use among high-risk adolescents

  • John P. Elder
  • James F. Sallis
  • Susan I. Woodruff
  • Marianne B. Wildey


Psychosocial tobacco use prevention programs are based on the assumption that refusal skills training will have a suppressive effect on the onset of use by enabling non-using adolescents to refuse offers of cigarettes and smokeless tobacco. The present study investigated this assumption with 389 high-risk junior high-school students involved in a prevention program during their seventh, eighth, and ninth-grade years. Direct behavioral measures of refusal skills were taken by having subjects respond to audiotaped offers of tobacco and then rating the quality of their responses. These ratings were then linked to tobacco use measures obtained at the end of each of the 3 study years. Results showed that the comprehensive prevention program produced a favorable trend in delaying or preventing the onset of tobacco use. However, the refusal skills training, which was carried out throughout the 3-year intervention period, produced significant differences in overall refusal skill quality only at the seventh grade. Moreover, refusal skill quality was not related to overall tobacco use or cigarette use at any grade.

Key words

tobacco refusal skills tobacco use adolescents prevention programs 


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  1. Cummings, S. R., Rubin, S. M., and Oster, G. (1989). The cost-effectiveness of counseling smokers to quit.JAMA 261: 74–79.Google Scholar
  2. Elder, J. P., Wildey, M., de Moor, C., Sallis, J. F., Eckhardt, L., and Edwards, C. (1993). The long-term prevention of tobacco use among junior high school students: Classroom and telephone interventions.Am. J. Publ. Health. 83: 1239–1244.Google Scholar
  3. Evans, R. I., and Raines, B. E. (1982). Control and prevention of smoking in adolescents: A psychological perspective. In Coates, T. J., Peterson, A. C., and Perry, C. (eds.),Promoting Adolescent Health: A Dialogue on Research and Practice, Academic Press, New York, pp. 101–136.Google Scholar
  4. Evans, R., Hansen, W., and Mittelmark, M. (1977). Increasing the validity of self-reports of smoking behavior in children.J. Appl. Psychol. 62: 521–523.Google Scholar
  5. Flay, B. R. (1985). Psychosocial approaches to smoking prevention: A review of the findings.Health Psychol. 4: 449–488.Google Scholar
  6. Glynn, T. J., Anderson, D. M., and Schwartz, L. (1991). Tobacco-use reduction among high-risk youth: Recommendations of a National Cancer Institute expert advisory panel.Prevent. Med. 20: 279–291.Google Scholar
  7. Hops, H., Weissman, W., Biglan, A., Thompson, R., Faller, C., and Severson, H. H. (1986). A taped situation test of cigarette refusal skills among adolescents.Behav. Assess. 8: 145–154.Google Scholar
  8. MacKinnon, D. P., Johnson, C. A., Pentz, M. A., and Dwyer, J. H. (1991). Mediating mechanisms in a school-based drug prevention program: First-year effects of the Midwestern Prevention Project.Health Psychol. 10: 164–172.Google Scholar
  9. Marcus, A. C., and Crane, L. A. (1985). Smoking behavior among Hispanics: A preliminary report.World Smoking and Health, Spring.Google Scholar
  10. McCaul, K. D., and Glasgow, R. E. (1985). Preventing adolescent smoking: What have we learned about treatment construct validity?Health Psychol. 4: 361–387.Google Scholar
  11. Pierce, J. P., Fiore, M. C., Novotny, T. E., Hatziandreau, E. J., and Davis, R. M. (1989). Trends in cigarette smoking in the United States: Projections to the year 2000.JAMA 261: 61–65.Google Scholar
  12. Sallis, J. F., Elder, J. P., Wildey, M. B., de Moor, C., Young, R. L., Shulkin, J. J., and Helme, J. M. (1990). Assessing skills for refusing cigarettes and smokeless tobacco.J. Behav. Med. 13: 489–503.Google Scholar
  13. Schinke, S. P., Gilchrist, L. D., and Snow, W. H. (1985). Skills intervention to prevent cigarette smoking among adolescents.Am. J. Publ. Health 74: 665–667.Google Scholar
  14. Schinke, S. P., Gilchrist, L. D., Schilling, R. F., Snow, W. H., and Bobo, J. K. (1986). Skills methods to prevent smoking.Health Educ Q. 13: 23–27.Google Scholar
  15. Sussman, S., Dent, C. W., Stacy, A. W., Sun, P., Craig, S., and Simon, T. R. (1993). Project Towards No Tobacco Use one-year behavior outcomes (under review).Google Scholar
  16. U.S. Department of Health and Human Services (1986). The health consequences of using smokeless tobacco. A report of the advisory committee to the surgeon general, 1986. USDHHS Public Health, Service NIH Publication No. 86-2874.Google Scholar
  17. U.S. Department of Health and Human Services (1989). Reducing the health consequences of smoking: 25 years of progress. A report of the surgeon general. USDHHS Publication No. (CDC) 89-8411.Google Scholar
  18. U. S. Public Health Service (1964). Smoking and health. Report of the Advisory Committee to the Surgeon General of the Public Health Service. USDHHS Public Health Service, PHS Publication No. 1103.Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • John P. Elder
    • 1
  • James F. Sallis
    • 2
  • Susan I. Woodruff
    • 1
  • Marianne B. Wildey
    • 1
  1. 1.Graduate School of Public HealthSan Diego State UniversitySan Diego
  2. 2.Department of PsychologySan Diego State UniversitySan Diego

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